Cognitive functioning in first episode and recurrent major depressive disorder: A systematic review and meta-analysis of comparative performance.
OBJECTIVE Major depressive disorder is associated with cognitive deficits, yet the specific impact of recurrence remains unclear. This systematic review and meta-analysis compared cognitive performance between individuals with first-episode depression (FED) and recurrent major depressive disorder (rMDD). METHOD Five databases were searched to identify eligible studies. A series of meta-analyses for each cognitive domain were conducted with inverse-variance, random-effects modeling. Demographic and clinical moderators were explored, with leave-one-out sensitivity analyses. RESULTS Twenty-four eligible studies were included in the review, of which data from 2,487 participants (k = 20; FEDn = 1,288, rMDDn = 1,199) contributed to meta-analyses. Relative to FED, rMDD showed statistically significant small to moderate effects indicative of poorer performance across several cognitive domains: processing speed (g = -0.20), auditory attention (g = -0.33), working memory (g = -0.47), verbal learning (g = -0.41), and verbal memory (g = -0.54), albeit the size of effect was found to vary dependent on the neuropsychological test or outcome measure. Over half the analyses resulted in nonsignificant differences in cognitive performance in rMDD versus FED. Findings remained relatively robust to leave-one-out analyses. No demographic or clinical variables reliably moderated effects. CONCLUSIONS Scarring effects of episode recurrence appear to impact a select few cognitive domains. To further advance understanding of cognitive heterogeneity across illness stages and to inform targeted interventions to mitigate possible worsening of cognitive function and relapse risk, longitudinal cognitive tracking is needed to elucidate when and under what circumstances recurrent episodes may exacerbate cognition. (PsycInfo Database Record (c) 2026 APA, all rights reserved).